random questions Flashcards
WHO definition of osteoporosis
Being outside the 2.5 x standard deviation of that age group
RF for osteoporosis
Oestrogen deficiency
Vit D insufficiency
Hyperparathyroidism
Smoking
Alcohol
Previous fracture
What is Ehlers Danlos syndrome?
Multi system connective tissue disorder characterised by abnormal collagen in skin, joints, blood vessels causing fragile vessels and elastic bones
In back pain, differentiate MSK from referred
MSK pain is mostly lumbar
Short-lived
Sudden
Relieved by rest
Referred is mostly thoracic
Constant and progressive
Difference between sepsis and septic shock
Severe sepsis shows organ dysfunction
Septic shock also has hypotension
What are the effects of persistant proteinuria in nephrotic syndrome
Loss of IgG - susceptibility to infection
Loss of coagulation inhibitors - hypercoagulability
Loss of apoproteins - Hyperlipidaemia
What are secondary causes of nephrotic syndrome
DM
SLE
Heroin Malaria Hepatitis HIV NSAIDs
Constituents and purpose of saline solution (0.9%)
Na 154mmol
Cl 154 mmol
Expands extracellular H2O
Constituents and purpose of Hartmann’s solution
130 Na 109 Cl 4 K 1.5 Ca 28 Lactate
Normalises pH if acidic
Constituents and purpose of 5% Dextrose solution
50g dextrose in 1 L H2O.
Expands body water, slightly more towards extracellular (CRYSTALLOID)
Constituents and purpose of Abumin solution
150 Na
136 Cl
<2 K
40-50 g Albumin
Extracellular volume expander (COLLOID)
What is used in the treatment of paracetamol overdose
N-acetylcysteine
Within 8-10 hours
Measure paracetamol plasma concentration to decide whether to treat or not
Causes of microcytic anaemia
TAILS Thalaessemia Anaemia of chronic disease Iron deficiency Lead poisoning Sideroblastic anaemia
Causes of normocytic anaemia
Acute blood loss
Haemolytic anaemia
CKD
Causes of macrocytic anaemia (megaloblastic)
Folate deficiency (alcoholics, haemolysis, pregnancy) B12 deficiency (vegetarians, pernicious anaemia, disease of terminal ileum such as Crohn's)
Character of bacterial meningitis
CSF: Turbid, purulent Marked increase in polymorphs Some increase in protein. <50% of blood glucose
There is a higher risk of complications with bacterial meningitis.
Which patients are at risk of subdural haemorrhage?
Elderly and alcoholics. Patients on anticagulants.
How does subdural haemorrhage present.
Long prodrome, may be weeks after a trauma until S&S.
Headache, drowsiness, confusion. Focal neurological deficits. Epilepsy. Stupor, coma.
Pressure atrophy of the brain because of fluid between dura and arachnoid.
Whar are differentials for stroke?
Hypoglycaemia
Tumour
Seizure
What is the triad of meningism?
Photophobia
Headache
Neck stiffness
Which scrotal swellings have associations with tumours and which don’t?
Hydrocele has association with tumour.
Also with infection and trauma.
Spermatocele has no association with tumour.
How many lumps can a hydrocele be?
more than 2 (because of association with tumours?)
How many lumps can a spermatocele be
only 1
Which factor indicates acute over chronic hepatitis
Raised WCC
What is the triad in nephrotic syndrome
proteinurea
hypoalbuminaemia
hyperlipidaemia
Oedema
What are the symptoms of autosomal PCKD
Haematuria
Bilateral palpable kidneys
Flank pain
Systemic disease (hernias, stones, HTN)
What is often the first indicator of liver damage in paracetamol overdose
Prothrombin time (INR)
What is achalasia
Oesophagus loses motility. Also, the valve at the GOJ does not open properly. Leads to food spillover into lungs.
Some relief from dysphagia during eating.
What is the commonest cause of nephropathy?
IgA nephropathy. Leads to concurrent URTIs.
Thin basement membrane disease.
What is the likely diagnosis if a patient has elevated serum urea but only mildly elevated creatinine?
Dehydration
What are the criteria for glomerular nephropathy
haematuria
proteinuria
hypertension
What is Stevens Johnson Syndrome
Rash on arms, leg, face.
Ulceration of lips and mouth.
Caused by acute drug sensitivity. Most commonly to antibiotics
Which factors in acute meningitis are suggestive of bacterial origin?
Hypotension
Leucocytosis (neutrophilia)
Renal impairment
What are causes of hyponatraemia
Often due to excess loss of fluid - sweating, diarrhoea, vomiting, burn.
Diuretics and Addison’s lead to renal loss of Na and H2O.
Hyponatraemia with hypovolaemia occurs with excess retention of water. (eg severe kidney failure).
SIADH (malignancy, neurological, or pneumonia).
With normovolamia - administration of too much IV hypotonic fluid.
How to rule out a subdural haematoma?
CT
What ar the key clinical features of diabetic ketoacidosis
Hyperventilation
Dehydration (there is high serum K)
What is suggested by an ABPI of <0.97
Arterial disease in the leg
Which extrarenal clinical features can point towards the cause of ARF
Lung basement membranes can be affected in Goodpasture’s.
Microvascular signs in eyes in DM/HTN.
Hepatorenal syndrome.
There may be signs of infection, if that is the cause.
Muscle pain in rhabdomyolysis.
Heart failure and endocarditis may be present.
Symptoms of pancreatic cancer in the body or tail.
Thrombophlebitis migrans (femoral vv, legs, arms - swollen and red).
Anorexia.
Pain radiating to back, relieved by sitting forward.
Acute pancreatitis, late onset DM.
Signs of pancreatic cancer
Jaundice Severe weight loss Palpable masses Palpable gall bladder Lymphadenopathy Ascites
Signs relating to liver metastasis indicate worse prognosis (eg. low albumin).
Symptoms of bladder TCC
Sterile pyuria
Painless haematuria
UTIs
Obstructive symptoms
Suprapubic pain relieved by lying down
Bladder calculi
The symptoms of adenocarcinoma of the prostate
Back pain
Weight loss
Anaemia
Progressive urinary tract obstruction.q
RF for renal calculi
Metabolic - acidic/alkalic urine
Infection
Dehydration
High Calcium in the diet
What are distinctions in the symptoms of lower and upper UTIs
Upper - loin pain, tenderness, fever, rigors.
Lower - suprapubic pain, frequency, dysuria
What is the indication of AXR in upper UTI diagnosis?
Shows most renal stones
Which sensations are lost first in diabetic symmetrical distal sensorymotor polyneuropathy?
“Walking on a cotton wool”
Vibration
Temp
Pain sensation
What is the pattern of callous formation in DM
Formation at the 1st metatarsal head.
Ulceration
Which nerves are most commonly affected in diabetic mononeuropathy
CN3
CN6
Pupillary reflexes are maintained.
Carpal Tunnel syndrome is also more common.
What is the aetiology of hyperthyroidism
80% Graves Disease
15% multinodular goitre
5% Solitary toxic adenomas
What are the main features of diabetic nephropathy
Albuminuria
More in T1DM
Normochromic, normocytic anaemia.
Advice high protein diet.
What are possible features of a malignant solitary nodule goitre?
Rapid enlargement.
LN enlargement.
Pain?
T3 toxicosis (production by adenoma).
How do multinodular goitres present?
15% of Hyperthyroidism.
Can also be euthyroid.
RARE to be hypothyroid or Malignant.
Local effects (laryngeal nn palsy, tracheal/oesophageal compression)
Which hormones can be secreted by tumours in the lungs?
ACTH
ADH (dilutional hyponatraemia)
PTH (hypercalcaemia)
What is a Pancoast tumour?
Invasive lung tumour near brachial plexus.
Pain radiating down to hands, muscle wasting.
What is Horner’s syndrome?
Lung tumour compresses sympathetic nerves. Triad of: Miosis Hemifacial ptosis Hemifacial anhidrosis
